The mediating effect of post-traumatic growth on the relationship between personality traits and resilience among a sample of Lebanese adults

Background Resilience plays a crucial role in mental health promotion and prevention, and was shown to be more represented in individuals who exhibit high levels of extraversion, openness, agreeableness, and conscientiousness. However, there is a lack of studies that comprehensively investigate the association between personality traits and resilience in Lebanon and Arab countries more broadly. The purpose of the present study was to complement the literature by investigating the direct and indirect effects between the five personality traits and resilience among a sample of Lebanese adults through the intermediary role of posttraumatic growth. Methodology A cross-sectional study was carried out between May and July 2022, and enrolled 387 participants, all aged above 18 years old and recruited from all Lebanon governorates. The questionnaire used included socio-demographic questions, and the following scales: Connor-Davidson Resilience Scale (CD-RISC) to assess resilience, post traumatic growth (PTG), and Big Five Inventory (BFI-2). The SPSS software v.25 was used for the statistical analysis. Results Post-traumatic growth mediated the association between extraversion / agreeableness / conscientiousness and resilience. Higher extraversion / agreeableness / conscientiousness was significantly associated with more post-traumatic growth. Higher post-traumatic growth was significantly associated with more resilience. Extraversion, but not agreeableness and conscientiousness, was significantly and directly associated with more resilience. Conclusion Findings suggest that fostering PTG in individuals who experience adversity can help promote their resilience. Hence, it could be beneficial to design and apply programs aiming at supporting PTG among people who experience stressful and traumatizing situations, to consequently help them increase their sense of resilience.


Results
Post-traumatic growth mediated the association between extraversion / agreeableness / conscientiousness and resilience.Higher extraversion / agreeableness / conscientiousness was significantly associated with more post-traumatic growth.Higher post-traumatic growth was significantly associated with more resilience.Extraversion, but not agreeableness and conscientiousness, was significantly and directly associated with more resilience.

Conclusion
Findings suggest that fostering PTG in individuals who experience adversity can help promote their resilience.Hence, it could be beneficial to design and apply programs aiming at supporting PTG among people who experience stressful and traumatizing situations, to consequently help them increase their sense of resilience.

Background
The increased prevalence of traumatic and tragic events, such as life changes, illness, pandemics, natural disasters, or wars, has generated significant interest from the fields of neuroscience, mental health, and psychology regarding their impact on mental well-being [1].Such stressful experiences have detrimental effects on mental health (e.g., [2][3][4]).However, not all individuals will be affected to the same extent.Many individuals exposed to trauma experience no significant negative psychological consequences or recover quickly from adversity [5,6].One reason for variations in response to trauma and a key factor in achieving good mental health is resilience [6].Some researchers define resilience as the ability to respond positively to stressful situations [7], while others view it as the ability to function normally facing persistent stress [8,9].Resilience is defined by the American Psychological Society as the act of "bouncing back" from tough events and effectively adjusting in the face of adversity, trauma, tragedy, threats, or severe levels of stress [10].When encountering difficulties, challenges and frustrations, individuals with higher resilience levels are often able to rapidly adapt the balance between situational needs and behavioral responses [11,12].Resilience can, therefore, be regarded as a major personal asset which may itself be affected by several factors such as personality traits [13].

The relationship between personality traits and resilience
Personality traits refer to unique characteristic patterns that derive and control each individual's thoughts, feelings and behaviors in a stable and sustained way influence on individual behavior and thoughts [14].The widely used five-factor model (FFM) [15] categorizes personality traits as extraversion (sociability and optimism), agreeableness (understanding and empathy), conscientiousness (organization, responsibility, and punctuality), openness (acceptance of new ideas and creativity), and neuroticism (mood instability and negative emotions) [16].Previous studies found moderate association between resilience and FFM traits, with estimated average correlation coefficients for resilience ranging from −0.46 for neuroticism to 0.42 for extraversion and conscientiousness [17].Resilient individuals tend to have high levels of openness, conscientiousness, agreeableness, and extraversion, and low levels of neuroticism [18].Earlier research suggested that extravert individuals who face stressful situations tend to exhibit more adaptive stress management [19].Generally, there is strong evidence that resilience is inversely associated with neuroticism and positively related to other personality traits (for meta-analysis, see [17]).In particular, extraversion and neuroticism traits were found to be significantly more impacted by life events [20,21], and to be, in turn, more specifically linked to resilience [22].Considering that resilience could potentially be the key to explaining how individuals exposed to stressful experiences deal with adversity across the lifespan and since the ways individuals respond to adversity stem from personality traits among other factors [17], it is of high importance to investigate the mechanisms underlying the relationship between the big Five personality traits and resilience.This study proposed to complement the existing literature by investigating the role of a potential mediator in this relationship, namely post-traumatic growth (PTG).

PTG as mediator
Posttraumatic growth (PTG) refers to a positive psychological change and cognitive adaptation following trauma, arising from surviving the experience and perceiving new life opportunities [23].Tedeschi and Calhoun [24] distinguished between resilience and PTG by highlighting that development after trauma involves transformative cognitive rebuilding.This process may be reflected through having an increased sense of personal strength, relating to others more, realizing new possibilities in life, gaining a greater appreciation for life, and making a spiritual or existential change [24].PTG entails a movement beyond pre-trauma levels of adaptation, whereas resilience means moving forward after difficult situations.As both PTG and resilience refer to dynamic psychological processes and transformation occurring after a trauma, PTG is assumed to have a close connection with resilience [25,26].From a theoretical perspective, positive psychological change experienced after potentially challenging circumstances could predict resilience.Indeed, PTG implies enhancement of the self and becoming stronger in the aftermath of trauma, which increases capacity for action and resistance to detrimental impacts [27,28].Previous studies demonstrated that PTG is closely associated with resilience [25,26].In other words, it has been suggested that experiencing PTG after trauma is related to an increased likelihood of exhibiting resilience characteristics [29][30][31].On the other hand, agreeableness, neuroticism, and extraversion were demonstrated to be significantly linked to posttraumatic growth (PTG), with agreeableness and extraversion positively affecting PTG and neuroticism having a negative impact [32].Previous research also suggested a positive association between openness to experience, extraversion, and PTG, with these personality traits reflecting a greater inclination for flexibility, exploration, and adaptation [33].

The present study
Before the 2020 pandemic, Lebanese faced crises in sanitation management, disruptions in essential services like water and electricity, as well as Lebanese pound corruption, impacting mental health and resilience [34].Following the Beirut blast, the remarkable resilience and adaptability of the Lebanese population in the face of trauma, tragedy, threats, or any significant source of stress became evident in their daily lives [35].Based on the literature above, the present study aims to test the following hypotheses: (1) the big five personality traits of nonclinical Lebanese adults may positively affect their resilience levels; (2) the big five personality traits may indirectly affect resilience through the intermediary role of PTG.

Study design
A cross-sectional study conducted between May and July 2022, enrolled 387 participants through convenience sampling in several Lebanese governorates (Beirut, Mount Lebanon, North Lebanon, South Lebanon, and Bekaa).The consent form, study purpose, anonymity assurance, and questionnaire were all sent to participants via an internet survey link.The link was distributed over social media using a snowball approach.All participants above the age of 18 were eligible to participate, and those who refused to complete the questionnaire were excluded.

Ethics approval and consent to participate
This study protocol (HPC-023-2022) was approved by the Psychiatric Hospital of the Cross Ethics and Research Committee.When submitting the online form, each participant was required to provide written informed consent.All procedures were carried out in conformity with the relevant guidelines and regulations.

Minimal sample size calculation
According to the G-power software [36], a minimum of 316 students was deemed necessary to have enough statistical power, based on a 5% risk of error, 80% power, f2 = 2.5% and 10 factors to be entered in the multivariable analysis.

Questionnaire
The questionnaire used was anonymous and in Arabic, the native language in Lebanon; it required approximately 10 to 15 minutes to complete.It consisted of two parts.The first part gathered participants' sociodemographic information including age, gender, region of living, marital status and education level.The Household Crowding Index (HCI), a measure of family's socioeconomic status [37], was calculated by dividing the number of individuals living in the house by the number of rooms (excluding the kitchen and the bathrooms).The scales used in the present study were included in the second part.

Connor-Davidson Resilience Scale (CD-RISC).
The CD-RISC contains ten items [38,39] each of which are scored on a 5-point scale ranging from 0 (not true at all) to 4 (true nearly all of the time); for example, "I am able to adapt when changes occur" and "I am not easily discouraged by failure."Higher scores on the CD-RISC-10 indicate higher levels of resilience (Cronbach's alpha in this study = .88).The Arabic validated version of the CD-RISC was used [40].
Post traumatic growth (PTG).This scale is composed of 10 items and measures favorable outcomes after a traumatic event [41].PTG items are rated between 0 to 5 with 0 indicates "I didn't experience this change as a result of my crisis" and 5 indicated "I experienced this change to a very great degree as a result of my crisis" [41].Higher score means higher post traumatic growth (Cronbach's alpha in this study = .95).This scale is validated in Arabic [42].

Statistical analysis
The SPSS software v.25 has been used for the statistical analysis.The resilience and PTG scores were considered normally distributed since the skewness and kurtosis values varied between -1 and +1 [45].The Student-t test was used to compare two means and the Pearson test was used to correlate two continuous variables.The mediation analysis was conducted using PRO-CESS MACRO (an SPSS add-on) v.3.4 model 4; four pathways derived from this analysis: pathway A from the independent variable to the mediator, pathway B from the mediator to the dependent variable, Pathways C and C' indicating the total and direct effects from the independent to the dependent variable.Results adjusted over age, gender, marital status, education level and household crowding index and the other four personality traits.We considered the mediation analysis to be significant if the Boot Confidence Interval did not pass by zero.P<0.05 was deemed statistically significant.

Sociodemographic and other characteristics of the sample
Three hundred eighty-seven participants participated in this study, with a mean age of 26.17 ± 11.47 years and 58.4% females.Other descriptive statistics of the sample can be found in Table 1.

Bivariate analysis of factors associated with resilience
The results of the bivariate analysis of factors associated with resilience are summarized in Tables 2 and 3.The results showed that extroversion, agreeableness, conscientiousness and open mindedness were significantly associated with more resilience and post-traumatic growth, whereas negative emotionality was significantly associated with less resilience.

Mediation analysis
PTG mediated the association between extraversion / agreeableness / conscientiousness traits and resilience (Table 4).Higher extraversion / agreeableness / conscientiousness was significantly associated with more PTG.Higher PTG was significantly associated with more resilience.Extraversion, but not agreeableness and conscientiousness, was significantly and directly associated with more resilience (Figs 1-3).

Discussion
Resilience plays a crucial role in mental health promotion and prevention [46], and was shown to be more represented in individuals who exhibit high levels of extraversion, openness, agreeableness, and conscientiousness [17].However, there is a lack of studies that comprehensively investigate the association between personality traits and resilience in Lebanon and Arab countries more broadly.The purpose of the present study was to investigate the direct and indirect effects between the five personality traits and resilience through the intermediary role of PTG.As expected, findings revealed that more extroverted, conscientious, and agreeable individuals reported significantly increased resilience in our study.This is in line with previous findings that PTG significantly affects resilience [47].This emphasized the importance of developing a mature and adaptable personality is advantageous for effectively coping with and recovering from stressful situations, as resilience involves adapting to life challenges and traumatic events.In addition, these findings increase awareness of persons' personality, which help people to understand their strengths and weakness in coping with life's challenges, and predict one's negative and positive aspects of wellbeing; especially among Lebanese adults imposed to burdens.
Additionally, analyses showed that PTG acted either as a partial or as a full mediator in the personality-resilience association.
Consistent with our findings, prior studies showed a positive correlation between conscientiousness, extroversion and agreeableness with each dimension of the resilience, as these traits *indicates significant mediation.Direct effect refers to the direct association between each personality trait and resilience without the effect of the mediator, whereas the indirect effect refers to the same association through the mediator (post-traumatic growth).
https://doi.org/10.1371/journal.pone.0298043.t004aid in handling challenges, enhancing adaptability, and fostering positive interpersonal interactions [16,48].Notably, it would be difficult to compare our findings with previous literature data, as research examining the mediating effect of PTG in the relationship between personality traits and resilience was not available.This study's results suggest that, by means of high levels of PTG, individuals with certain stable personality traits [49] may activate beneficial coping strategies [50]; for example, conscientious people seek distractions or take action to resolve problems.Another explanation could be that high levels of extroversion, conscientiousness, agreeableness and high levels of PTG are linked to a strong sense of having control over circumstances, which may increase the ability to act proactively and resist to potential negative outcomes [27,28].

Study limitations and strengths
Limitations of our study include the cross-sectional design, hindering causal inference.In addition, participants may have over or under estimated some questions, which may result in information bias.A web-based method was adopted to collect data, which might have limited the generalizability of our sample to the broader general adult population, especially since this approach has mostly attracted young adult participants.Finally, residual confounding bias is possible since other variables influencing resilience were not considered in this study.However, our study was the first to assess the mediating effect of PTG on the association between personality and resilience using validated scales and sound sample size.

Clinical implications
The current study provides further support to the positive association between specific personality traits (i.e., extraversion, agreeableness, conscientiousness) and resilience.Findings showed that this might occur through both direct and indirect effects.Highly extroverted, conscientious, and agreeable individuals tend to report greater levels of PTG, which subsequently contribute to experiencing a heightened sense of resilience.This suggests that fostering PTG in individuals who experience adversity can help promote their resilience.This means that it could be beneficial to design and apply programs aiming at supporting PTG among people who experience stressful and traumatizing situations, to consequently help them increase their sense of resilience.Future research is still required to identify other potential mechanisms (mediators/moderators) underscoring the relation personalityresilience.

Conclusion
In light of the present findings, it can be suggested that developing the main personality traits contributing to resilience in the Lebanese population fosters a better adapted and resilient personality for coping with daily stressors and crises.The mediating effect of PTG between personality traits and resilience implies that there is a strong need to develop and implement intervention strategies targeting PTG, as this might potentially enhance resilience in individuals who face adversity.Future longitudinal studies are needed to confirm our assumptions and deepen knowledge on the mechanisms affecting the relationship between personality and resilience.